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Substance abuse occurs with the excessive use or misuse of a drug beyond its
intended purpose or prescription. The most commonly abused substances are alcohol and
prescription drugs. All use of illegal drugs is considered substance abuse. The most
common reason for drug and alcohol abuse is the desire to achieve a certain feeling or
sensation. Substance abuse, if not treated, often leads to dependence. The DSM defines
substance abuse as manifested by one or more of the following in the same 12-month
period:
Recurrent substance use resulting in a failure to fulfill major role obligations at work,
school, or home
Recurrent substance use in situations in which it is physically hazardous
Recurrent substance-related legal problems
Continued substance use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of the substance
Drug dependence on a substance develops when the brains neurons adapt to
repeated drug exposure and only function normally in the presence of the drug. When the
drug is withdrawn, several physiologic reactions occur. The two main hallmarks of
dependence are tolerance and withdrawal symptoms. The DSM defines dependence as
manifested by three or more of the following in the same 12-month period:
Tolerance, as defined by either of the following:
1 A need for markedly increased amounts of the substance to achieve
intoxication or desired effect.
2 Markedly diminished effect with continued use of the same amount of the
substance.
Withdrawal, as manifested by either of the following:
1 The characteristic withdrawal syndrome for the substance
2 The same substance is taken to relieve or avoid withdrawal symptoms.
The substance is often taken in larger amounts or over a longer period than was intended.
There is a persistent desire or unsuccessful efforts to cut down or control substance use.
A great deal of time is spent in activities necessary to obtain the substance, use the
substance, or recover from its effects.
Important social, occupational or recreational activities are given up or reduced because
of substance use.
The substance use is continued despite knowledge of having a persistent or recurrent
physical or psychological problem that is likely to have been caused or exacerbated by
the substance
The terms dependence and addiction are often used synonymously and often go
hand in hand. Addiction of any kind is the display of compulsive behavior. In the case of
drug and alcohol abuse, this compulsive behavior is reinforcing or rewarding to the user,
in spite of the negative consequences of their behavior. A major feature of addiction is the
loss of control when it comes to abstaining from the substance. Scientists have learned a
great deal about the biochemical, cellular, and molecular bases of addiction; it is clear
that addiction is a disease of the brain. When a person is addicted to a substance, the use
of that substance targets certain cells in the brain, which triggers a feeling of reward or
satisfaction.